Friday was spent shepherding my patient from the oncologist to the social worker, and then to see his primary physician. At the oncologist's office, we had to talk realistically about the fact that the cancer, spreading within his non-healing wound where his rectum used to be, is almost impossible to treat. We'll try our best, but the chemotherapy will only buy us some time, and perhaps lead to other sufferings needing treatment themselves. Side effects may become untenable: blood dyscrasias (altered blood counts), infection, nausea and vomiting. With no possible cure, the medicine may be worse than the disease itself. The decision to end treatment---even if it is only palliative and not curative---will need to be an ongoing and subject to change based upon outcome along the way. The choices are painful, and I will be intimately acquainted with this process.
Choosing whether or not to receive cancer treatment which may prolong life briefly---and perhaps prolong suffering as well---is a very personal choice. Whether I would make the same choice is a good question. But at this time, shepherding---midwifery---is my place, and we embark on the journey once again.